A ketogenic diet for energy, mood stability and an end to anxiety

Dr. David Jockers, is interviewed on the topic of the ketogenic diet on the Mental Wellness Summit 2, which airs online September 25 – October 2, 2017. The title of his interview is “Ketogenesis for Energy Stability” but I feel it could be called “Ketogenesis for Energy, Mood Stability and an end to Anxiety.” It’s a brilliant interview and he starts by sharing how the brain can use ketones and not only sugar:

We know that about 2/3 of the brain energy can be produced by ketones. We used to think that basically the brain depended upon sugar as its only energy source. And it does need a small amount of sugar, and that’s why it’s so important we have to have a certain level of blood glucose. However, as we get keto-adapted, when we start to utilize ketones as an energy source, the brain gets much more effective and efficient, and it needs less of the sugar.

And that’s important because sugar produces a lot more metabolic waste. And so when the brain is using ketones, there is going to be less free radical damage and what we call oxidative stress in the brain, so less damage being associated with the various neurons in the brain therefore better connection, better communication.

Ketones act to induce healthy genetic expression. They’re epigenetic influencers where they actually influence the brain to promote more BDNF (brain derived neurotrophic growth factor), which helps grow more neurons and more synapses (little gaps between the neurons). They help produce more neurotransmitters and really optimize the expression of these neurotransmitters to where we get good sensitivity between the neurons.

So when the neurons secrete serotonin, the next neuron is able to actually connect with that very easily and realize “hey, this is the message that we need to get across.”

Dr. Jockers then goes into the relationship between GABA and glutamate and how the ketogenic diet improves the ability of glutamate converting into GABA:

There is a relationship between glutamate, which is an excitatory neurotransmitter in the brain, and GABA, which is an inhibitory neurotransmitter. Glutamate naturally converts into GABA when certain nutrients are present – like magnesium and vitamin B6 – along with a properly working GAD enzyme.

Now, when we have ketones present, they have been shown to improve the ability to convert glutamate into GABA.

Individuals with anxiety or obsessive compulsive [disorder] often have excessive amounts of glutamate, which can cause too much excitation in the brain and something called excitotoxicity that damages a whole bunch of different neurons, and causes massive neuronal death in parts of the brain. It can lead to symptoms like anxiety, headaches, migraines and seizures. The ketogenic diet has been shown in many studies to be a very powerful remedy for seizure disorders like epilepsy. That’s where this neuropharmacology of the ketogenic diet was analyzed in detail where they came up with the understanding that it impacts this glutamate to GABA conversion.

When we have adequate amounts of GABA and this proper relationship of glutamate to GABA, we feel very emotionally balanced and calm. We are able to fall asleep well. We have less pain in our body, and less susceptibility to headaches. In general, we just feel very emotionally balanced, and that’s what we’re going for.

Ketones are a huge help when it comes to that. When you’re in a state of ketosis, your natural feeling should be that you just feel awesome. You feel like a high performer. You feel at peace and you feel calm. That’s a sign that you’re in ketosis. If you are on a low carb ketogenic diet but you’re noticing irritability, anxiety and headaches, you’re actually not using the ketones. Your body is not actually keto-adapted. Instead, you’re in a hypoglycemic mode where your blood sugar is too low. You’re not using the ketones, and you’re getting exitotoxicity in your brain.

He goes on to share what a ketogenic diet should look like:

Avocados, coconut oil, coconut butter, coconut flakes, coconut milk, grass-fed butter, so butter or ghee (which is clarified butter from grass-fed cows) olives, olive oil. You want at least one of those in every single meal and you want a lot of it in every single meal.

Dr. Jockers shares about how much protein to eat, what proteins to eat, what fruits and vegetables and how much to eat, how he cycles in and out of ketosis, how he uses intermittent fasting, his favorite supplements to support ketosis (magnesium threonate is one of them), his favorite adrenal adaptogens and much more.

I know they are referring to medications but I find it quite funny that the hosts say the “magic pill” solution is not the answer. As you’ll hear in my interview, the dangers of benzodiazepines and why GABA is a more effective option for anxiety, I believe that GABA (and tryptophan and the other amino acids) are truly “magic pill” solutions that help so many seeking relief while they dig deeper for other contributing root causes and start to make dietary changes, whether it’s switching to real whole foods, quitting gluten, removing all grains or implementing a ketogenic diet.

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Comments

All sounds fabulous and enticing but…. I hate to rain on anyone’s parade but a high fat ketogenic diet like the one he recommends is not at all safe for the likes of us who have the APOE4 gene and have been warned to not go anywhere near a high fat diet and to actually almost avoid all saturated fat as advised by Dr C, Donna Gates etc etc… What is the next best option for us? They rarely mention this important issue when heralding a ketogenic diet which actually could be doing many people a lot of serious harm. My cholesterol skyrocketed to dangerous levels when I went high fat. What are your thoughts Trudy?

Drew
As I’ve mentioned to you before I’m still on the fence about the specifics of this. He doesn’t mention this at all even though he does say when this dietary approach should not be used (adrenal issues, pregnancy and hormone issues in women and hypothyroidism sometimes). It’s a great question to ask him during the summit. What other questions do you have? I would love to interview him!

I would also want to know which cholesterol marker increased as there are many and high levels of certain markers like triglycerides, Lp(a) and Lp-PLA2 (together with high blood pressure, high CRP, high fibrinogen) are more concerning than say high total cholesterol.

Drew
I wasn’t expecting you to share all this 🙂 but now I’d be curious to see what it looks like when you’re not on a high saturated diet AND what comprises a high saturated diet and a low saturated diet (although there are many other variables like supplements, thyroid health gut health, carb intake, stress, sleep etc)

He also shares this in another article: “While low-carbohydrate diets may be beneficial for many people struggling with high cholesterol and heart disease, it is important to note that this approach may not be appropriate for those who have elevated cholesterol due to genetics, such as familial hypercholesterolemia or the ApoE4 gene. A better dietary approach for these individuals would be a “Mediterranean Paleo diet” that emphasizes the consumption of more whole foods-based carbs and leaner cuts of meat, while reducing intake of added fats and saturated fat.” https://kresserinstitute.com/functional-perspective-diet-cholesterol/

Drew
I received this feedback from Dr. Jockers: “For those with APOE4, I typically recommend the same strategies as these individuals struggle with long-chain saturated fats and not short and medium chain. They may benefit from less fatty meat (stick with leaner forms), eggs and grass-fed butter but can still do well on coconut fats and MCT oil and a new product that I just started using called SCT oil (short chain fatty acid oil). Of course, doing a lot of avocados, olives and olive oil which are full of mono.”

Interesting! Thanks so much for sharing Trudy. That’s pretty much what I am doing already, may have to reduce egg consumption a bit, I tend to have 2 eggs for breakfast Mon, Weds, Fri, Sat and Sun. Interesting that coconut oil is ok – I thought it was the most saturated of all?

I have created a diet called “The Essential Diet; Eating for Mental Health” and it emphasizes the healthy fats – in essence it is ketogenic. It is a wonderful resource for people! I’d also like to add that excess glutamate can be a trigger for mania so that is another important reason to follow “The Essential Diet’ and the suggestions made in this great blog!

Dr. Christina
Wonderful! Your book is great as a resource for low carb eating for mental health but the ketogenic diet Dr. Jockers discusses has even more healthy fats (MCT oil is a big one he recommends) and even less carbs than what you recommend. He also advocates intermittent fasting.

And yes, I agree about the glutamate trigger for mania.

Thank you for the work you do! And so glad we got to meet last month in San Diego!

I firmly believe that following a ketogenic diet actually led to horrible anxiety! Not right away but over time, it was only after adding back quality carbs like roots , potatoes, lots of fruit and yes even small amounts of sugar balanced with quality protein have i started healing. Before that i tried every supplement , was positive that i was pyrolauric , and had extreme social anxiety . When i made the food switches it was like a night and day difference.

Kelly
Thanks for sharing – good for you for listening to your body. This diet is not for everyone.

I’d be curious to know the state of your adrenals. Dr Jockers shares that those with adrenal issues should not use this diet – “as they try to get into keto adaptive state, their body will release too much adrenaline because adrenaline is the back up to cortisol. So if the body is not able to produce cortisol for whatever reason, the brain’s not able to communicate well to the adrenal cortex, then it’s going to use the backup, which is adrenaline, which has an amplified effect on the adrenals and that individual may end up with issues like heart palpitations” (which could look like anxiety)

I’d love to hear what you were eating and the ratios of carbs/fats/proteins – on the ketogenic diet and then when you started feeling better?

He does recommend adding back small amounts of carbs one day a week. He also says pregnant women and women with menstrual issues should not use this approach either, and he uses it on a case by case situation in those with hypothyroidism.

I’ve also heard other practitioners share advice about using a modified keto diet for all their female patients.

Ehmm, I cannot think of a single woman who would qualify for this diet then?
Perhaps this is related to my job but… I cannot think of a single woman over 35 who has no hormonal issues, good adrenal health, no thyroid issues.
For those who did qualify at one time, they wrecked their bodies with too much, too extreme exercise (perhaps extreme diets like veganism or one meal-a-day type regimes) and now sit on the HPA dysfunction axis.

I was suffering from terrible anxiety and horrible insomnia for over a year. I do have high cortisol. The sleep deprivation along with a VERY busy brain caused me to feel as though I was going crazy. I became almost nonfunctional. Out of desperation I went to see a conventional psychiatrist who put me on Lamictal , a “mood stabilizer” , which I believe helps to regulate glutamate . It does seem to help but I do not want to stay ontheis medication. If you could provide more information on how to decrease glutamate levels without going on a ketogenic diet or a mofified ketogenic diet, that would be extremely helpful.
Thank you
Margaret

I recommend discussing with your doctor and reading my book “The Antianxiety Food Solution” (on amazon here http://amzn.to/2kptFWm) so you have all the foundations of diet, gut health, blood sugar control etc (which is very valuable for mood issues) plus there is an entire chapter on the amino acids. Share it with your doctor too.

I will say Trudy that I am very grateful for your insight on gaba that has helped a lot too, and i on occasion still use it. Interestingly my tolerance of it has increased and over time ive had to increase the dosage for it to work . Thankfully its not something i have to use regularly thanks to my improved diet. As to ratios to my former diet i dont know, i did eat a lot of veggies and protein and was liberal in my fats, now i eat a lot of fruit and potatoes not as much fat and of course protein and veggies. I was fortunate to come accross eastwesthealing that explains how the keto diet increases cortisol, and the impact on blood sugar , i know there philosophy may be different but it made a life changing difference. Overall im thankful for all the things i learn from everyone . With this i finally feel like my adrenals are healing!

Thanks for this Trudy and for sharing the excellent articles which I read with interest – I recall seeing them before but it was good to be reminded. Yes, when I next have my CV Health done it will be interesting to see the results. I have been following a “Mediterranean Paleo diet” for a while and have reduced the intake of fats and saturated fats quite a bit…

Drew
It’s always good to see before and after results and these will give you and your practitioner more confidence in your approach. I’d love to hear when you do get the after results to see if the diet changes have made an impact.

Hi, Trudy
I’ve followed the keto diet before and felt absolutely fantastic; I lost weight and my anxiety disappeared- but so did my period. After listening to Dr Jockers’ talk on the benefits of the keto diet, I decided to try it again, but making sure this time to add in a ‘feasting day’ of carbs, as he suggests to let the body know it isn’t starving. Yet again, my period disappeared, only to come back after going back into carbs (my period is very regular normally, though I have had issues in the past- a long time on hormonal contraceptives, endometriosis) I’m presuming that because my body thinks it’s starving, the last thing it wants is to support another life through pregnancy. I wonder if you’ve heard of this phenomenon and what the best solution is? I’ve read that the keto diet principle is based around a man’s physiology and doesn’t take into account female sex hormones….. I love feeling awesome, but think it’s important to maintain a regular period also.